The Safe Practice of Female Genital Plastic Surgery

Abstract

Summary: The purpose of this article is to guide surgeons in the safe practice of female genital plastic surgery when the number of such cases is steadily increasing. A careful review of salient things to look for in the patient’s motivation, medical history, and physical examination can help the surgeon wisely choose best candidates. The anatomy is described, with particular attention given to the variations not generally described in textbooks or articles. Descriptions are included for labiaplasty, including clitoral hood reduction, majoraplasty, monsplasty, and perineoplasty with vaginoplasty. Reduction of anesthetic risks, deep venous thromboses, and pulmonary emboli are discussed, with special consideration for avoidance of nerve injury and compartment syndrome. Postoperative care of a variety of vulvovaginal procedures is discussed. Videos showing anatomic variations and surgical techniques of common female genital procedures with recommendations to reduce the complication rate are included in the article.

An Algorithm for Labia Minora Reduction Based on a Review of Anatomical, Configurational, and Individual Considerations

“…(5)(6)(7)(8)(9)(10) Rather, the technique should be chosen in accordance to the expectations and anatomical features of each individual patient. (5,(10)(11)(12)(13)(14) To date, some classifications have been presented to guide this choice, most of them based on labia minora width measurement,(15) labial configuration, (10,13,16) or a combination of both. (8,17) Only very few authors actually paired the various classes with various labiaplasty techniques, thereby offering a true algorithm.…”

“…Patients and physicians may consciously or subconsciously differ in opinion as to the aesthetics of labia minora. (5,10,14,20,28,30,31) Like holds true for all aesthetic considerations, cultural influences (e.g. peers, media, art) largely define accepted standards of normality.…”

“…Patients and physicians may consciously or subconsciously differ in opinion as to the aesthetics of labia minora. 5 10 14 20 28 30 31 Like holds true for all aesthetic considerations, cultural influences (e.g., peers, media, art) largely define accepted standards of normality. 13 20 26 32 Most women in Western culture perceive a symmetrical vulva with minor labia and a clitoral hood tucked inside the major labia as normal.…”

“… 5 6 7 8 9 10 Rather, the technique should be chosen in accordance with the expectations and anatomical features of each individual patient. 5 10 11 12 13 14 …”

“…To do so, we found we had to (re-)define some of the terms used regarding labiaplasty. The terms width and length , 10 14 19 20 21 for instance, are used inconsistently for what would in French medical literature and stereometrically be referred to as “height.” 22 23 24 Furthermore, we (re-)assessed the considerations relevant to the choice of labiaplasty technique.…”